Authorizations, Admissions, Coverage and Referrals
Authorizations and Coverages
As a Medicaid provider, understanding authorization requirements, coverage guidelines, service limitations and referral processes is essential for delivering compliant and timely care. Our resources outline processes for obtaining prior authorizations, inpatient admission criteria, and key coverage details to help you navigate Medicaid regulations effectively. Following these guidelines reduces delays, prevents claim denials, and ensures patients receive necessary care within program parameters.
Our goal is to support your practice with accurate information and efficient workflows, so you can focus on what matters most—quality care for your patients. These guidelines clarify when authorizations are needed and how to submit requests to ensure timely care.
Guidelines and Policies
Chorus Community Health Plans (CCHP) will not reconsider services, procedures or inpatient stays for which we have not received provider notification. Providers must notify CCHP within 24 hours of an inpatient admission and obtain prior authorization for elective serves and procedures before providing care.
Please reference your provider agreement for inpatient admissions for more details.
Clinical Documentation: Attach clinical documentation to requests within 24 hours. Without clinical information to review for medical necessity, your service request may be denied.
UM Department Availability: Monday - Friday, 8 a.m. - 5 p.m. Messages are confidential and can be left 24/7. Messages left after business hours will receive a response the next business day.
Draft Authorization Reminder: Check daily for authorizations in draft status that have not been submitted. CCHP is not notified until the authorization has been submitted.